| Learning Objective #1: Understand the importance of fetal head position during labour and the rationale for use of maternal hand and knee positioning during labour | |||
| Learning Objective #2: Understand the effects of maternal hand and knee positioning during labour on fetal head position, persistent back pain, operative delivery, and other important labour and birth outcomes |
Objectives: During labour, occipitoposterior (OP) fetal head position (FHP) is associated with operative delivery, perineal trauma, longer labour and persistent back pain (PBP). Although 5% of deliveries are in OP position, 33% of women experience PBP during labour, suggesting malposition is a common problem. Maternal adoption of hands and knees (HK) positioning may promote fetal head rotation via gravity and buoyancy. Questions: For women labouring with a fetus in OP position, what is the effect of maternal HK positioning on: FHP after use of the position; PBP; operative delivery; FHP at delivery; perineal trauma; Apgar scores; time to delivery; maternal feelings of control and views about positions used? Design: Randomized, controlled trial with prognostic stratification for parity and anesthesia. Sample, Setting: 146 women from Canada, US, UK, Australia, Israel, Argentina. Consent was sought from labouring women presenting with symptoms of OP position. Methods: Following confirmation of OP position by ultrasound, women were randomly assigned (computerized service) to intervention (>30 minutes of HK positioning, over 60 minutes) or control (60 minutes of usual care positioning) group. Variables: FHP (primary outcome) determined by ultrasound. PBP measured by McGill Pain Questionnaire. Labour Agentry Scale measured maternal feelings of control. Other outcomes gathered by chart review. Findings: PBP was significantly reduced when women used HK positioning. There were consistent trends toward benefit of use of HK positioning for fetal head rotation following use of the position, FHP at delivery, operative delivery, Apgar scores at one-minute, and length of time from randomization to delivery, but sample size may not be sufficient to determine if these differences are real. Women who used HK positioning would do so again. Conclusions: Evidence from this trial suggests that HK positioning is beneficial for relief of PBP, is acceptable to labouring women and may improve other labour and delivery outcomes.
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